Better children through chemistry?

The number of American children taking drugs to combat attention deficit disorder (ADD)
has grown to between 1.5 million and 3 million; the number taking antidepressants is also
rising. Does this mean that a problem is being taken care of, or that a problem is being
created? The answer depends on one's point of view. Some psychiatrists, psychologists, and
parents think the press has sensationalized the coverage of Ritalin (methylphenidate) and
other psychopharmaceuticals for children. An article in Parade magazine calls the
use of Ritalin controversial. An editorial in the Wall Street Journal, headed "Attention
Deficit Disaster," questions whether ADD even exists.

"People ask, 'Where does the Ritalin controversy come from?' In the scientific community
there is no controversy," says Dr.
Russell Barkley, director of psychology and professor of psychiatry and neurology at the
University of Massachusetts Medical Center in
Worcester. Ritalin is the drug of choice for ADD, he says, and a physician who does not
consider prescribing it for a child with the disorder could be accused of malpractice.

"I think the press has tilted a bit toward emphasizing possible overprescribing of Ritalin,
which is a legitimate concern, and not given enough attention to the benefits of Ritalin when
given to properly diagnosed patients," says Dr. Jack M. Gorman, professor of psychiatry and vice chair for research at
Columbia's College of Physicians &
Surgeons. The subject is simply not treated fairly, even in major magazines, says Barkley.
It is his experience that news stories about ADD and the use of Ritalin and other drugs
contain shreds of scientific data presented in the worst light, with outrageous headlines or a
tabloid spin.

On the other hand, to those who believe ADD is overdiagnosed,
ill-defined, or nonexistent -- or who regard the use of pediatric psychopharmaceuticals as an
attempt to produce "better children through chemistry" -- the coverage may be more accurate.
Several articles in the lay press note that the percentage of ADD diagnosis and Ritalin use
varies greatly within the United States, not only from state to state but town to town and is
much higher in the United States than anywhere else in the world. Part of the problem is that
no hard-and-fast tests exist for ADD or other psychological problems such as depression.

Recent articles also render dueling statistics. A July article in the online magazine Salon stated that 3 million American children receive amphetamines (including Ritalin) to
control ADD or ADD with hyperactivity and another 600,000 take antidepressants such as
Prozac (fluoxetine). The article does not give the source of the statistics, but an October 1996
Associated Press story cites the National Association of School Nurses as
saying that Ritalin is being used by 3 million school children. A study published in Pediatrics in
December 1996 gives lower numbers, stating that 1.5 million children ages 5 through 18 take
Ritalin.

"To my knowledge, there are no studies that actually document overdiagnosis, but there is the
concern that some children may get Ritalin who don't have ADD, just as some children get
antibiotics for sore throats when the diagnosis of strep throat hasn't been made," says
Gorman.

Barkley points out that much information against psychopharmaceuticals has came from the
Church of Scientology and its Citizens Commission on Human Rights
(CCHR). He has often debated on talk shows with people who doubt that ADD exists at
all, he notes. Not all critics of psychopharmaceuticals are from CCHR, but the organization is
active in debating this and other areas of psychiatry.

Dr. Laurence Greenhill, medical director of the Columbia-Presbyterian Medical Center's
Disruptive Behavior Disorder Clinic and a researcher at the New York State Psychiatric Institute,
notes a surge of anti-Ritalin stories in the late 1980s when the CCHR was questioning use of
the drug, but that the national support group Children and
Adults with Attention Deficit Disorders (CHADD) has been a factor in getting better
coverage. "CHADD has been a very strong influence in terms of promoting full treatment for
kids, all forms of treatment," he says. Still, Greenhill thinks most press coverage has been well-
handled. "There are sometimes concerns about medications, but they are based on
hearsay."

That the sensationalism may be subsiding could be due to CHADD's advocacy, as Greenhill
notes, or that more journalists have had experience, either personal or professional, with
someone who has ADD or uses these medications. The use of psychopharmaceuticals such as
Ritalin is not as much of a stigma as it once was, adds Greenhill. Taking medications at
school--any medication--was once a subject of ridicule, he says, but now so many children do
it for so many different medical conditions that it has been widely accepted.

CHADD
was described in the Wall Street Journal editorial as "'having grown powerful by
feeding parents' concerns about [ADD]". For its part, CHADD keeps track of stories about
ADD and publishes a "Media Watch" column in its newsletter. In the October/November
1997 issue, the column cited the WSJ editorial and noted that CHADD sent a
rebuttal letter that was never published. As Joan Aho Ryan, director of communications for
the organization, notes in the column, "Our goal is not to eliminate all negative coverage.
Obviously, that's not realistic." The goal, she states, is to get objective and accurate news
about ADD to the public. Given society's widespread disagreements about disorders like
ADD, however, disagreement about what defines objectivity and accuracy in press coverage is
unlikely to subside. --Valerie DeBenedette